PTSD Post-Traumatic Stress Disorder

What is PTSD Post-Traumatic Stress Disorder?

Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder. It may occur among individuals who have witnessed or experienced a traumatic event (accident, sexual violence, natural disaster, rape, death threat, terrorist act/attack, war/combat, burn, or serious injury).

PTSD has also been referred to as "shell shock" during the era of World War I and "combat fatigue" immediately after World War II. However, this condition is not restricted to combat veterans. It can occur in all individuals of any ethnicity, gender, nationality, or culture and at any age.

Individuals with PTSD suffer from extreme, disturbing thoughts and feelings associated with their experiences. Patients tend to relive the event through flashbacks or recurrent nightmares. They may experience extreme feelings of sadness, fear, or anger. It is also common for individuals to feel detached or estranged from other people.

Stages and Types of PTSD Post-Traumatic Stress Disorder

Stage 1 - Impact and Emergency Stage: The stage directly follows the traumatic event. This is when the individual struggles to deal with the trauma they have witnessed or been involved with.

Stage 2 - Denial and Numbing Stage: This is not a common stage. Some individuals with PTSD try their best to defend or numb themselves by completely denying the event's occurrence. It is an act of using denial to keep difficult emotions at bay while making sure it does not hurt anymore. Patients are recommended to deal with this stage to move forward. Meeting with a compassionate, experienced professional is the best way to address this stage.

Stage 3 - Rescue Stage (Intrusive or Repetitive stage): Individuals with PTSD begin coming to terms with the trauma that occurred in their life. A medical professional may ask them to return to the site of the trauma. The process involves acknowledging the occurrence incident while continuing to deal with shock and distress. Many people with PTSD may continue experiencing nightmares and recurrences. At this stage, they are overwhelmed with various emotions, such as confusion, denial, despair, and hopelessness. This is also known to be the most destructive of all stages. However, it can be helpful to allow an individual with PTSD to confront the trauma.

Stage 4 - Short-term Recovery and Intermediate Stage: An individual with PTSD starts their journey to recovery and adjusts to get back to a 'normal' life. This stage needs much love, support, care, and concern from other loved ones. This stage involves the patient's transition to a new level of approval and understanding of the trauma. Most individuals heal during this process and even develop a positive outlook.

Stage 5 - Long-term Reconstruction (Recovery) Stage: A medical professional will implement a recovery program into the treatment plan of a PTSD patient. This involves creating coping mechanisms and helping patients learn to address symptoms. Individuals with PTSD are suggested to integrate these mechanisms into their daily lives to encourage them to look forward. This fifth stage can be a long journey. Patients may feel they are regressing under a stressful situation and triggering events. The key is implementing coping strategies and skills developed through a recovery program that helps patients continue dealing with their life.

Types of PTSD: PTSD usually starts with a normal stress response and gradually develops into PTSD. Here are the common types of PTSD one can be categorized into:

Normal Stress Response: As mentioned above, PTSD may begin with a normal stress response, allowing the body to fight or leave the situation by activating adrenaline. Once the threat is over, the body turns to pre-arousal levels. The response does not have a long-term effect on one's mind. Psychotherapy and support from loved ones can help.

Acute Stress Disorder: The condition develops after a traumatic event. The symptoms start between 3 days and one month after the event. Treatment often includes psychotherapy to reduce symptoms and the chances of symptoms developing into PTSD.

Dissociative PTSD: This form of PTSD shows dissociative symptoms (depersonalization or de-realization). The individual also becomes emotionally detached. Doctors might suggest exposure-based therapy for managing these symptoms.

Uncomplicated PTSD: The condition shows symptoms of other types of PTSD without coexisting with other mental health conditions, such as depression. It is one of the most commonly diagnosed PTSD and is highly responsive to treatment.

Complex PTSD: The condition results from repeated or multiple traumas that happen over months or years. It can cause issues in relationships and behaviors. Treatment often takes longer. Recovery is also slower. Complex PTSD should be handled by a team of trauma specialists who can create a structured management plan designed for the individual based on their condition and symptoms.

Co-morbid PTSD: It is a common type of PTSD. The condition leads to at least one co-occurring mental health condition, such as anxiety disorder, substance use disorder, panic disorder, and major depressive disorder. Treatment often includes controlling symptoms of PTSD and other mental health conditions.

Symptoms of PTSD

Intrusion: Patients experience intrusive thoughts such as repeated, instinctive memories; disturbing dreams; or recurrent flashbacks of the traumatic event (similar to reliving the traumatic experience or witnessing before their eyes).

Avoidance: Patients tend to avoid reminders of the traumatic event, such as avoiding people, objects, places, activities, and circumstances that may trigger stressful memories. They may also resist talking about the incident.

Changes in Cognition and Mood: The patients live with ongoing and distorted beliefs about themselves or others, blaming themselves or others and feeling detached or estranged from others. Most individuals are also unable to experience positive emotions.

Changes in Arousal and Reactivity: Symptoms of arousal and reactive may include being short-tempered and getting angry outbursts. Patients may behave irresponsibly or in a self-destructive way. They are overly watchful or suspecting of their surroundings, get easily shocked, or have trouble concentrating or sleeping.

Risk Factors of PTSD

It is essential to understand that risk factors for PTSD can be present before, during, or after a trauma. These include:

Before a Trauma

• A history of other traumas
• A history of other mental health conditions
• A family history of mental health conditions

During a Trauma

• Facing traumas such as sexual assault or the sudden death of a loved one
• Detaching during the trauma
• Believing threat to life during the trauma
• Experiencing severe trauma
• Physical injury or particular types of injury (head injury or loss of consciousness)

After a Trauma

• Excess life stress
• Avoidance of coping
• Little or less social support
• Negative social interactions

Causes of PTSD

Post-traumatic stress disorder (PTSD) develops after a traumatic, scary or distressing event. Sometimes, it is an after-effect of a prolonged traumatic experience.

The following types of events are known to be major causes of PTSD:

• Serious accidents
• Physical / sexual assault
• Torture
• Abuse (childhood or domestic)
• War and conflict
• Exposure to traumatic events at work
• Serious health conditions
• Childbirth experiences (loss of a baby)
• Loss of a loved one

Studies have revealed that about 1 in 3 people who experience severe trauma tend to suffer from PTSD. Although the exact reason why people develop PTSD is not clear, several probable reasons have been proposed:

1. Survival Mechanism: It is suggested that symptoms of PTSD may be the result of an automatic mechanism intended to help an individual survive further traumatic experiences.
2. High Adrenaline Levels: Studies have revealed that individuals with PTSD have abnormal levels of stress hormones (produced by the body under dangerous situations to trigger a reaction). This reaction is also referred to as the "fight or flight" reaction, which helps to mute the senses and dull pain. PTSD patients continue to produce high amounts of fight-or-flight hormones even under normal situations.
3. Changes in the Brain: The part of the brain responsible for emotional processing experiences changes in individuals with PTSD. The Hippocampus (part of the brain accountable for memory and emotions) appears smaller in size in individuals with PTSD.

Prevention of PTSD

Trauma is not restricted to affect a specific gender, race, or caste. It can happen to anyone. The present-day estimation states that about 70% of adults in America have experienced trauma at least once. Around 20% of these individuals tend to develop PTSD owing to their experiences. PTSD occurs due to trauma getting "frozen in time" in an individual's brain. These individuals can re-experience the trauma after several years like it "just happened recently."

Taking specific steps can help prevent a traumatic event from developing into PTSD. These include:

1. Discussing the events plays a crucial role in the healing process.
2. Grieving is normal. It is not a sign of weakness. The process can help with successful healing.
3. Making efforts to alter traumatic thoughts is important. The patient should identify the specific thoughts that occurred during the traumatic event and work towards replacing them with positive thoughts of recovery.
4. It helps to learn how to recognize triggers to relieve thoughts or feelings that occurred during the trauma. This helps overcome them.
5. Patients should disconnect the triggers to cut off from strong emotions that occurred during a traumatic event. This process reduces the risk of developing PTSD.
6. Seek therapy is the most critical part of preventing trauma from developing into PTSD. Professional therapy can help patients deal with feelings of being unsafe.

Frequently Asked Questions

• Diagnosis and Treatment